• Collaborative

Taking care of yourself while taking care of others

H. Poncet-Kalifa, psychologist, Dr. C. Stordeur, child psychiatrist


In these times of major health crisis, healthcare personnel are currently supported by the entire population. They are recognized for their dedication and involvement. But a healthcare personnel is still a human being. A human being who, through the missions related to his profession, is exposed to difficult, stressful and/or emotionally straining situations, in addition to the anxiety that this epidemic can generate in everyone. At this moment, missions entrusted to us are changing, instructions are modified as the situation evolves. When confronted with the unusual, one may find oneself weakened in self-confidence and doubt. In this exceptional context, it is all the more important to take care of yourself and also of your colleagues, especially the youngest (interns, externs...).

I observe the impact of what I experience: signs of fatigue, somatization, isolation, avoidance...

When faced with a difficult situation, these signs are often observed:


- Sleep disturbances, difficulty falling asleep, nightmares...

- Feeling of helplessness, incompetence, guilt, absurdity...

- Brutal and frequent comeback of images, sensations and emotions related to the day that just passed

- Irritability, need for isolation and withdrawal, feeling of despondency

- Loss of appetite or eating disorders

Be vigilant so that you can respond appropriately. If the signs mentioned above take on disturbing proportions or if they last over time, it is recommended that you seek psychological help. For example with the staff psychologist, Ms. Nguyen Duy Mat on 01 40 03 57 19, with a telephone orientation platform: 01 42 34 78 78 or the “Ecoute-Soignants-COVID” hotline: 01 40 25 67 11/0140256713/01 40 25 67 19. The SPS association also has a hotline: 0 805 23 23 36. Psychological help is all the more effective as it intervenes quickly.

I take care of myself:


I take care of my lifestyle: diet, physical exercise, sleep. I live as much as possible with a regular schedule. I limit my consumption of alcohol and tobacco, especially before bedtime. I avoid the news channels continuously, I can read the news on reliable dedicated apps/websites. I plan daily pleasant activities, which rejuvenate me: listening to music, a podcast, reading, watching a movie, a series, taking a bath, calling a friend ... I can note 3 positive moments daily. You will find suggestions in the “Self-care wheel” and its Quebecker formulations.

I seek for social support:


I identify the persons with whom I am comfortable to share my emotions, my worries, my pain and also the persons with whom I feel pleasant emotions, with whom I easily have a good time. I take advantage of messaging applications to keep contact, I do not hesitate to mute them if I feel the need (especially for groups of colleagues), and I keep in touch with my loved ones (video calls, phone, emails...). I allow myself to express my needs to my loved ones, for example when I don't want to talk, to tell. I can take inspiration from assertiveness techniques:

When

Describe the problematic situation

I feel

Describe your feelings

I would like

Express your need

Make a request

For example: “When I come home after my work day, I still feel a bit in my head at work, I would like to have a little quiet time to reconnect by taking a shower”.

In all circumstances, I can practice breathing exercises

We use abdominal breathing: inspiration comes from the nose by swelling the belly, exhalation through mouth as if we were blowing in a straw, or as if we were blowing on the flame of a candle just to make it wobble by digging the belly. The main thing is not to breathe in more than you breathe out (this avoids the anxiety-provoking effects of hyperventilation).

Cardiac coherence exercises:


· With a visual (ctrl + click to follow the links): https://66.media.tumblr.com/b1406ea40336dc68e5404b380c391d96/tumblr_nsj9tcMOgY1qkv5xlo1_500.gif

· In the free version “Petit Bambou”, you can choose the number of respiratory cycles per minute.

· Counting up to 5 on inspiration and up to 5 on expiration for 1 minute.

Vagal respiratory maneuver:


· Release the air already in your lungs, without forcing, as if you let a balloon empty.

· Then breathe in through your nose, counting to 3.

· Block your breathing by counting to 3.

· Exhale slowly, counting to 6.

· You can choose the number that you are most comfortable with, the main thing is to always breathe out twice the inspiration and feel good. In addition to the calming feeling of this breath, counting allows you to focus on something else and distract yourself from unpleasant thoughts.

Karate of worries:


· Position your arm horizontally, in front of you, imagining that you are holding in your closed fist a negative feeling, a difficult moment.

· When inhaling, bend your arm backwards so that your elbow is on the same level with your shoulder (as if you were arming a bow).

· Then breathe out strongly by stretching out your arm and imagine that you are launching this feeling as far in front of you as possible.

· Repeat this 3 times, for each fist, then with both fists at the same time.

Relaxation and mindfulness exercises:


To practice these exercises, you have to put yourself in conditions favorable to relaxation: choose a quiet place, make sure not to be disturbed, adopt a comfortable posture but not slack, and uncross arms and legs. It is normal to go into your thoughts, each time it happens try to refocus on what you hear or on your breathing ... It is also an exercise that develops attentional skills! Don’t forget that relaxation is above all a tool and not an end in itself. With training, it becomes easier and easier to relax. It is advisable to choose a time to exercise every day, for example when you wake up. Don't hesitate to test different approaches to find what works best for you.

References:

Fatigue, reception of bodily sensations:

https://www.youtube.com/watch?v=FU1839S7hb0 https://wetransfer.com/downloads/616c2158689f015d44a2c3d7a942dec620160112213756/8d6163

https://sites.uclouvain.be/mindfulness/mp3/Balayage

Managing emotions:

https://www.youtube.com/watch?v=DXUt0ZzCmRg https://wetransfer.com/downloads/e95c87a6edf950a021d5afdb92831eed20160112230832/c61ec9

Painful, unpleasant sensations:

https://www.youtube.com/watch?v=GQSVqNf8dC0 https://wetransfer.com/downloads/d427ddbf73a43ea51f1aba551eee805620160108230540/b5f670

Ruminations, thoughts:

https://stephanypelissolo.wetransfer.com/downloads/a6d8f4412bf9fe56fc93a16a5ea35b8a20171230144037/05b aa7

Feeling solid in turmoil:

https://wetransfer.com/downloads/343a9ae71cf1fc840ee076897a56527520160516163158/3a7a18

Sites with many resources to test:

http://www.stephany-orain-pelissolo.com/meditations1

https://mindfulness.cps-emotions.be/materiel-adulte.php

https://www.mbct-france.fr/fichiers-audio

https://www.mbct-formation.com/meditations-guidees

Petit Bambou application: possibility of free access for 3 months for APHP healthcare personnel

References:

Transforming Pain: A workbook on vicarious traumatization by Saakvitne, Pearlman & Colleagues from TSI/CAAP (Norton, 1996). Created by Olga Phoenix Project: Healing for a social change (2013). Training survivors of terror, S. Goujard, AFTCC

Thank you to all the persons who leave audio or video meditation materials in free access...

Translated by Stéphanie Antoun (pediatrician)

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris